Will we soon see a revision in recommendations for the early detection of prostate cancer? Hard to say at this point, but those pushing for a rewrite have certainly built up a stack of supporting evidence lately.
On the heels of an advisory by the U.S. Preventive Services Task Force that most men not get tested for prostate cancer, a large trial has concluded that annual screening for the disease doesn’t reduce the risk of dying from it. Reuters recently reported that a comparison of men who received yearly PSA tests to those who just got regular check-ups found more men in the screening group were diagnosed with prostate cancer, but there was no difference in how many died from it.
“Men, if they’re considering screening, should be aware that there’s a possibility that there’s little or no benefit (and) that there certainly are harms to PSA screening,” said study co-author Philip Prorok of the National Cancer Institute. Such harms, he told Reuters, include catching and treating small cancers that never would have been detected or caused men any problems.
Dr. Philipp Dahm, a urologist from the University of Florida (and who wasn’t involved in the report), said that following men who get screened annually limits the effectiveness of the study. But Dr. Scott Eggener, a urologic cancer specialist from the University of Chicago Medical Center (also not involved) calls it a serious flaw: “It ends up being a study of intensive screening versus fairly intensive screening,” he told Reuters Health.
MedBen currently follows the American Cancer Society recommendation that screening should begin at age 50 for men who are at average risk of prostate cancer, but that they should first speak with their doctor about the procedure’s risks as well as its benefits. Men at high risk of getting the disease should start screening at age 45.
The Midwest has finally been hit with its first blast of winter weather, and many of us will mark the occasion by breaking out the snow shovel. And with the fluffy white stuff comes the inevitable warnings about shoveling – especially for those who are older, out-of-shape or have a history of heart problems. But are such admonishments legitimate, or just the advice of overprotective worrywarts?
The New York Times recently looked into the claim that shoveling snow raises the risk of a heart attack, and finds there’s some truth to it. An Ontario study of 500 patients who arrived at the hospital with heart problems during two winter seasons found that about 7% of the patients were shoveling snow when symptoms hit. Most were older men with a family history of premature cardiovascular disease.
A smaller study found that the heavy physical exertion of shoveling causes trauma to coronary arteries, resulting in a heart attack. The best way to avoid danger, experts say, is to shovel early, when snow is lighter, and take breaks.
The conclusion reached by the Times: “The exertion involved in shoveling can rupture plaque and cause heart attacks, particularly in those with a family history.” So bottom line, take it easy out there this weekend!
Just 1% of Americans accounted for 22% of health care costs in 2009 – about $90,000 per person – according to a new report by the Agency for Healthcare Research and Quality. A USA Today story on the report says that U.S. residents spent a total of $1.26 trillion that year on health care.
While the finding spotlights how the health status of a small segment of the population can impact overall health care spending, it actually represented a reduced concentration from an earlier report. In 1996, the top 1% of the population accounted for 28% of health care spending.
Most of the top 1% of spenders tended to be white, non-Hispanic women in poor health; the elderly; and users of publicly funded health care. About one in five health care consumers remained in the top 1% for at least two consecutive years.
In the top 10% of health care spending in 2008 and 2009, 80% were white, 60% were women, and 40% were 65 and over. Only 3% in that bracket were ages 18 to 29, and just 2% were Asian.
The report also found that 5% of Americans accounted for 50% of health care costs, or about $36,000 each.
Supporters of a soda tax as a way to discourage the consumption of sugary drinks now have some added ammunition from the scientific community. Medical News Today reports that a new study concluded that a penny-per-ounce tax would result in an approximately 15% reduction in beverage consumption and reduce the risk of of obesity, diabetes, and cardiovascular disease.
Researchers at Columbia University Medical Center and the University of California, San Francisco used data from a national nutrition survey and a questionnaire on food choices to investigate how a decrease in sugary drink cunsumption would impact health. Based on that information, they estimated that, over a ten-year period, the penny-per-ounce tax could reduce new cases of diabetes by 2.6%, as many as 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths.
In pure dollars and cents, the researchers determined that the health benefits from the soda tax would save over $17 billion over a decade in medical costs avoided for adults aged 25, and generate approximately $13 billion in annual tax revenue.
The article states that sugar-sweetened drinks are the largest source of added sugar and excess calories in the American diet, and quite possibly, the single greatest dietary factor in the current obesity epidemic. Many states already impose a soda tax, but experts believe they are too low to influence consumption.
Sometimes, it seems that not a week goes by that common wisdom doesn’t get turned on its head. Repeatedly, we’ve been told that taking aspirin regularly can help healthy people to prevent heart disease. But a new report says such advice is not only groundless, but harmful as well.
Reuters (via Yahoo! Health) reports that researchers reviewed nine previous trials of aspirin use in people who had never shown signs of heart problems. Based on the data, they could find no evidence that aspirin prevented fatal heart attacks. It did apparently cause a small reduction in non-fatal heart attacks, though no more than taking a placebo.
Such minor benefits, however, are more than offset by an increased risk of serious bleeding from stomach ulcers and other conditions – as much as 30%, said Dr. Kausik Ray, who studies heart disease prevention at St. George’s University of London and led the study. “It is actually not net benefit, it is a net harm.”
“What we need to focus on is lifestyle, smoking cessation, and statin and blood pressure medications,” Ray added. “I don’t recommend aspirin.” The article notes, however, that among other teams of scientists who have recently analyzed the same data Ray looked at, one team did interpret the results in favor of aspirin.
Not overeating at a restaurant can be a tricky business. Portions are usually larger than you’d have at home, and the fact that you’re paying for it provides extra incentive to clean your plate. But researchers from University of Texas at Austin think they have a solution for eating healthy when eating out.
Their strategy, called “Mindful Restaurant Eating,” encourages diners to pay close attention to what they’re consuming, favor smaller portions, and heed the signs that they’ve had enough. Eating healthy outside the home, the researchers say, doesn’t mean subsisting on steamed vegetables, but having a plan to avoid excess calories and sticking to it.
Some tips from the research participants, according to HealthDay News (via Yahoo! Health):
National health care spending continued its slow growth in 2010, according to a new report from the Department of Health and Human Services. The 3.9% increase was lower than the rise in gross domestic product of 4.2%, and a far cry from previous double-digit jumps in the 1980s and 1990s.
A Kaiser Health News article on the report notes that premiums for individuals in private health insurance plans grew by 2.4% in 2010, while insurers’ spending on actual benefits rose only 1.6%. That disparity has invited multiple interpretations of the data. The Centers for Medicare and Medicaid Services, for instance, thinks the recession is to blame: With more uninsureds and greater out-of-pocket costs, patients sought care less frequently.
Karen Ignagni, president of America’s Health Insurance Plans, sees it another way. The portion of premiums “allocated to health plans administrative costs was among the lowest in recent years, despite the fact that health plans have been incurring new compliance and regulatory costs related to the health care reform law,” she said.
Health care analyst Tom Miller of the American Enterprise Institute believes the spending trend is a positive sign. “We may have broken the old dynamic, where there’s an ingrained force that says we will spend more on health care than we do on other things,” he said.
Two items regarding a couple lesser-known Affordable Care Act provisions:
John Goodman’s Health Policy Blog reviews the status of Consumer Operated and Oriented Plans (CO-OPs), alternatives to existing health insurance options. Scheduled to take effect in 2014, CO-OPs allow for the creation of non-profit insurers via government loans, available to individuals and small business and run by their customers.
The Health Policy Blog highlights an Urban Institute “interim assessment” of CO-OPs, which lists the challenges the program faces based on its design. Among them: Insufficient time to build clients and provider networks, prohibition of using the loan funding for marketing and “propoganda", and restrictions on insurance industry and government involvement.
In addition to these limitations, sponsors have to jump through plenty of hoops to start up a CO-OP. According to the Urban Institute paper, applications for funding must include “a feasibility study, a detailed business plan, a detailed budget with narrative and a timeline for meeting various milestones, including the necessary state regulatory approvals” – tasks made all the more difficult when available expertise is narrowed to those currently outside insurance and government.
The Washington Post Wonkblog recently reported on the quiet demise of health care reform’s Consumer Assistance Program. Funds for the service, created to help state residents find affordable health insurance coverage, were halted when Congress couldn’t agree on a new federal budget.
The blog post highlighted the closing of the Texas program, which was given a $2.8 million grant and hired nine employees to staff a toll-free hotline. Before shutting down, more than 6,000 Texans used the service – which, as a follow-up post notes, works out to about $466 per call.
It’s a good news/bad news day for the makers and users of nicotine patches, which are designed to help people stop smoking:
WebMD reports that nicotine patches may actually improve the brain performance of people with mild memory loss, often an early warning sign of future dementia. A small study of senior adults, all showing signs of early memory loss, found that the group who wore 15-milligram patches were better able to pay attention and demonstrated better long-term memory than the group who were given a placebo.
“The patients improved enough that they noticed the difference,” says researcher Paul Newhouse, MD, a professor of psychiatry at Vanderbilt University School of Medicine. He also noted that nicotine appears to incrementally improve memory the longer the patches are used.
Researchers from Harvard School of Public Health and the University of Massachusetts had less pleasant news to announce: A “real world” study of people trying to kick the cigarette habit determined that nicotine patches and gum are no more effective in the long term than going cold turkey, Medical News Today reports.
Rather than relying on clinical studies, the research team tracked adult smokers trying to quit, surveying them multiple times over a six-year period. In each period analyzed, about one-third of quitters had taken up smoking again, and the odds of relapsing were equally great for those who had used nicotine replacement products as those who had not – even when the patches and gums were combined with professional counseling.
Teeth get all the glory, but it’s time to pay the gums a bit of respect as well. After all, they do all the heavy lifting that allow you to bite, nibble and when you’re upset, grind. And when your gums get infected, they may be sending signals that bigger problems lurk beneath the surface.
According to WebMD, nearly 75% have some form of periodontal disease, better known as gum disease. It can be caused by poor oral hygiene as well as tobacco use, stress, poor nutrition and many other factors.
Equally troubling as gum disease itself is the impact it may have on other medical conditions. Research has linked gum disease with heart disease, diabetes, lung problems, and premature and low-birth-weight babies.
The best defense against gum disease is taking care of your teeth through daily brushing and flossing. And two times a year, visit a dental professional who can help detect, prevent, and treat gum disease and the disorders that accompany it.
MedBen Dental incorporates affordable coverage, sound dental principles and responsiveness to the needs of your employees, in a plan that stresses regular check-ups and good dental hygiene. Every dentist can participate in the plan, so employees can continue to use their family dentist or any other dentist of their choice.
Employers can offer MedBen Dental benefits as a standard plan on a voluntary basis. To learn more, please call Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
On Friday, the Obama administration submitted a 62-page filing with the Supreme Court defending the constitutionality of the individual mandate, ABC News reports.
In the filing, Solicitor General Donald B. Verrilli contends that the Affordable Care Act was passed to address the national crisis that has arisen from shifting the health care costs of the insured to other market participants. “The Act breaks this cycle through a comprehensive framework of economic regulation and incentives that will improve the functioning of the national market for health care by regulating the terms on which insurance is offered, controlling costs, and rationalizing the timing and method of payment for health care services,” Verrilli writes.
Verrilli also argues that requiring most Americans to buy health insurance by 2014 or pay a fine will help “to expand the availability and affordability of health insurance coverage.”
As to challengers’ claims that the Commerce Clause of the Constitution does not give Congress the authority to force someone to buy a product, Verrilli counters that everyone will need health care at some point in his or her life, and that the individual mandate offers a viable method to fund that care.
Getting a flu shot is a good thing – we’ve said as much on this blog. But immunization is only half the battle in preventing a bout with the bug.
Speaking to Medical Xpress, primary care physician Sri Murthy, MD says avoiding illness begins with a sink, hot water and soap. “Washing your hands before eating, during food preparation, after bathroom use, after touching surfaces in common areas and/or after blowing your nose or sneezing greatly reduces the amount of germs on your hands and prevents the spread of illness.”
Murthy notes that cold weather keeps us indoors at home and work, making us more vulnerable to germs carried in the “stale, warm air.” Furthermore, because many of us eat meals or snacks at our desk, our workstations may be teeming with illness-causing germs. A University of Arizona study found the typical worker’s desk has hundreds of times more bacteria per square inch than an office toilet seat. (We know, eww.)
“These findings are disturbing, but by practicing simple office hygiene – like washing your hands, cleaning your desk with antibacterial cleaner weekly, properly washing any reusable eating utensils, and finally, getting out of the office every once in awhile for lunch or just for a quick walk – can help,” Murthy says. In fact, a regular exercise regimen can bolster the immune system, she adds.
We’ll get the bad news out of the way first. Cancer is still the second-leading cause of death behind heart disease. And the incidents of some forms of cancer, including skin, liver and kidney, are actually on the rise.
But the American Cancer Society does have some positive news to offer. A new report concludes that overall cancer death rates have dropped through 2008, continuing a nearly 20-year-long trend. That means over one million Americans who would have been expected to die from the disease did not, according to WebMD.
The declines, the ACS report found, were due in large part to decreases in lung cancers in men and breast cancers in women. A greater emphasis on cancer screenings have contributed, said Michael V. Seiden, MD, PhD, president and CEO of Fox Chase Cancer Center. He did note, however, that the numbers could and should be better.
“The colonoscopy screening rates are nowhere where they should be, but they are slowly creeping up. The mammography screening rates are better as compared to a decade ago,” Seiden said.
MedBen Worksite Wellness recommends regular colonoscopy and mammography screenings, based on age and gender. The program also stresses the importance of an annual wellness exam, as well as testing for cholesterol, PSA and pap smear. Practicing timely preventive care greatly improves the chance a cancer or other disease can be detected and treated successfully.
Worksite Wellness members can check their compliance with critical wellness examinations by visiting the MedBen Access website and clicking on the Wellness Plan link under “My Plan”.
The Obama adminstration appears to have the momentum going into the Supreme Court case over the individual mandate, seeing how they’ve got a winning record in federal appeals courts. But throughout the legal process, the administration hasn’t adequately answered one question: If Congress has the constitutional power to make almost every American buy health insurance, where does that power stop? The Hill website reviews several judicial perspectives on the issue.
The 11th Circuit Court of Appeals struck down the individual mandate in part because the administration didn’t address the limits of regulartory power. “Ultimately, the government’s struggle to articulate… limiting principles only reiterates the conclusion we reach today: There are none,” the court said in its ruling.
Conversely, the U.S. Circuit Court for the District of Columbia upheld the mandate, while acknowledging in its opinion “some discomfort with the government’s failure to advance any clear doctrinal principles limiting congressional mandates that any American purchase any product or service in interstate commerce.”
In lower courts, the Justice Department contended that health care is different from other forms of commerce. As hospitals must treats all patient regardless of their ability to pay, the system incurs unpaid bills, which are ultimately passed on to insured people and the government. No other product, they claimed, involves the same type of cost-shifting.
That argument doesn’t sufficiently address the issue, said Ilya Shapiro, a legal scholar at Cato Institute. “The DOJ has to do a better job of answering, ‘What goes beyond your theory of federal power?’ They’ve been asked this in every court and they’ve never satisfied the court, even in the cases they’ve won.”
It should come as no surprise that health club memberships go way up in January: some gyms see enrollments spike as much as 50%. And competing clubs are happy to offer incentives to draw in New Year’s resolutioners, such as free initiations and lower monthly fees.
But while joining a gym can pay off in better health, it can also be a pricey proposition if you’re not careful. Men’s Health (via MSNBC.com) offers some tips to avoid new member gimmicks, we which summarize below:
One additional suggestion: check with your employer before beginning a gym search. Many businesses – MedBen among them – have negotiated discounts with local fitness clubs. And you may be able to enroll (and cancel) directly through your human resources department, saving you a bit of hassle.
Recent research by eHealth demonstrates how unhealthy habits can hurt the pocketbook as well as the body. As the results from this Smoking Status and BMI study show, average monthly premiums paid for individual health insurance are negatively impacted by cigarettes and improper diet (via Stone Hearth News):
On the group insurance level, such disparities are not as readily apparent, but unhealthy habits certainly do affect overall health care costs. At MedBen, we encourage our plan members, regardless of their current health status, to start off 2012 on the right foot with a visit to their family doctor. And if you’ve been meaning to kick the cigarette habit or lose that spare tire, there’s no better time than now.
The Pharmalot blog reports that when it comes to generic drugs, bigger is definitely not better. The FDA has put several drugmakers on notice that their drug applications will not be approved until the tablet size is more in line with the brand-name drug, citing safety and efficacy problems for patients.
A letter to one manufacturer reads: “The larger tablet size poses greater potential safety issues such as choking, tablet arrest and prolonged transit time, which could result in esophageal injury and/or pain. The larger tablet size also raises product efficacy concerns due to patients’ inability or unwillingness to swallow the larger tablets… Therefore, from a clinical standpoint, this product is unacceptable for approval as a generic and we recommend that you redesign your product to be closer in size to the relevant strengths” of the brand-name medicine.
As blog writer Ed Silverman points out, however, the FDA failed to provide “any guidance to the companies about acceptable differences in size” – as in, exactly how big is too big? Moreover, does this action reflect a more sweeping policy that will affect existing tablets as well?
If the agency does introduce across-the-board size restrictions, it could possibly require a bigger investment by the drugmakers – costs that could potentially be passed onto the patient. Of course, this is merely speculation at this point.
HealthDay recently posed the question, “Is American medicine too test happy?” According to the article, doctors are wondering the same thing, based on a growing body of evidence that overuse of diagnostic testing – say, a blood test followed by an ultrasound, topped off by an electrocardiogram – may be harming patients’ health and driving up health care costs.
“There is clear overuse or misuse of certain kinds of tests for certain patients,” said Dr. Steven E. Weinberger, executive vice president and chief executive officer of the American College of Physicians. Weinberger and Dr. Anthony Shih, executive vice president for programs of the Commonwealth Fund, identified three primary risks associated with diagnotic testing:
As for the cost factor, some experts estimate that excessive testing wastes upwards of $250 billion a year – an amount equal to about 10% of the total amount spent on the nation’s health care.
But acknowledging the need for restraint begs another question: Who is responsible for keeping testing in check – the doctor or the patient? Weinberger thinks both play an important role. “There needs to be an honest conversation in both directions, with a clear understanding about what is and isn’t necessary,” he said.
MedBen encourages its plan members to discuss pending diagnostic tests with their physicians, in order to better understand their purposes and potential risks. The Cleveland Clinic offers several lists of questions to ask your doctor, ranging from symptoms and diagnosis to treatment and surgery.
Ohio, Michigan and Illinois are among 23 states that have been awarded nearly $300 million for providing health coverage for children, Reuters reports (via Yahoo! Health).
States qualified for the bonuses by adapting procedures that make it easier to enroll and retain coverage under the Children’s Health Insurance Program (CHIP), a program that provides matching funds to states for health insurance to families with children. Administered by the Department of Health and Human Services, CHIP was created to cover uninsured children in families with incomes that are modest but too high to qualify for the Medicaid program.
Qualifying states also had to exceed the enrollment target set by Medicaid for low-income Americans and facilitate children’s enrollment in that program as well.
Enrollment in CHIP has risen by 1.2 million since 2009, according to the Centers for Disease Control and Prevention.
Two new studies offer a cautionary note for those of us who are seldom found without an MP3 player and a pair of earbuds:
HealthDay reports that about 90% of New York City residents may be at risk of hearing loss due to noise exposure. And while the din of subways and other transit modes contribute to the decline, MP3 players appear to play the greatest role nowadays.
The researchers gathered information based solely on information about work and leisure activities volunteered by participants, so the study is far from conclusive. But lead author Richard Neitzel of the University of Michigan said the findings suggest that auditory dangers are prevalent in the urban environment. “We need to step up our efforts to encourage people to protect their hearing,” he advised, and added that medical professionals need to “do a better job educating people that listening to music, if it’s loud enough, can hurt you.”
According to Medical News Today, one in four teens is in danger of early hearing loss as a result of listing to MP3 players at high volumes. Researchers at Tel Aviv University studied teens’ music listening habits and took acoustic measurements of preferred listening levels. Based on their findings, they theorize that teens misusing personal listening devices (PLDs) today could experience signs of hearing loss as earlier as their 30’s.
“In 10 or 20 years it will be too late to realize that an entire generation of young people is suffering from hearing problems much earlier than expected from natural aging,” says Prof. Chava Muchnik of TAU’s Department of Communication Disorders. She recommends that PLD manufacturers adopt the European standards that limit their output of to 100 decibels.